* Meeting with Laurene Powell Jobs, founder and chairwoman of Emerson Collective* Meeting with business leaders on infrastructure plans* Meeting with Democratic Representative Elijah Cummings* Meeting with Democratic Representative Peter Welch* Meeting with Redonda Miller, President of Johns Hopkins Hospital & Medicine* Meeting with Ryan Zinke, Secretary of the Interior, Representative Daniel Sullivan and Senator Lisa Murkowski* Meeting with Conservative leadersip for legislative agenda* Hosting with First Lady Melania Trump dinner for Senator Ted Cruz and Heidi Cruz* Hosting members of the House Freedom Caucus for an evening of bowling at the White House

“The president was clearly very much aware what was going on. He understood the issue very well,” Cummings told reporters afterwards. “And he felt it was important that we address this issue head-on.”“We told him that he’s going to have a difficult time with his own party, that was going to be the most difficult thing, and he said he really didn’t care,” Cummings said. “He said that that [this was] something very important to him … he agreed that the people in the Rust Belt, just like the people in Baltimore, need relief." “I got the main commitment that I wanted,” Cummings said. “[But] his proposal would go a little bit further than ours, in that he wants government-wide [drug negotiations].”

Price, a physician and former House lawmaker who headed the House Budget Committee, has opposed granting those negotiating powers, along with most other Republicans on Capitol Hill. But Trump, according to Cummings, asked Price to move on the issue.

Cummings said Trump is also voicing his support for another drug policy reform: the end of the current prohibition on Americans buying their prescription drugs abroad. Cummings has sponsored such a bill, along with Sen. Bernie Sanders (I-Vt.), but Republicans are largely opposed.

“He brought that up and said he had absolutely no problem with pushing that kind of legislation,” Cummings said, adding that he was “kind of surprised” Trump was endorsing the idea. “He said that as long as the safety considerations were in the legislation that he could be supportive … He volunteered that.”

"Marco Rubio is a choke artist, sweating all over the place. He was soaking wet, like he just came out of a swimming pool. We can't have that as a president". -Donald Trump

Nunes chastised the media for taking Trump’s words at face value. The president had merely posed a question about being wiretapped, Nunes argued, even as reporters said Trump’s statement had been far more definitive.

“As you all know, the president is a neophyte in politics. And I think a lot of the things he says, you guys sometimes take literally,” Nunes said to the press.

“Sometimes he doesn’t have 27 lawyers and staff looking at what he does … I don’t think we should attack the president for tweeting.”

"The enemy isn't men, or women, it's bloody stupid people and no one has the right to be stupid." - Sir Terry Pratchett.“The Grand Canyon is a minor crevice compared to the vast chasm of ignorance of that man,” - Salmond about Donald Trump

“The president was clearly very much aware what was going on. He understood the issue very well,” Cummings told reporters afterwards. “And he felt it was important that we address this issue head-on.”“We told him that he’s going to have a difficult time with his own party, that was going to be the most difficult thing, and he said he really didn’t care,” Cummings said. “He said that that [this was] something very important to him … he agreed that the people in the Rust Belt, just like the people in Baltimore, need relief." “I got the main commitment that I wanted,” Cummings said. “[But] his proposal would go a little bit further than ours, in that he wants government-wide [drug negotiations].”

Price, a physician and former House lawmaker who headed the House Budget Committee, has opposed granting those negotiating powers, along with most other Republicans on Capitol Hill. But Trump, according to Cummings, asked Price to move on the issue.

Cummings said Trump is also voicing his support for another drug policy reform: the end of the current prohibition on Americans buying their prescription drugs abroad. Cummings has sponsored such a bill, along with Sen. Bernie Sanders (I-Vt.), but Republicans are largely opposed.

“He brought that up and said he had absolutely no problem with pushing that kind of legislation,” Cummings said, adding that he was “kind of surprised” Trump was endorsing the idea. “He said that as long as the safety considerations were in the legislation that he could be supportive … He volunteered that.”

HEALTH CARETrump’s Strategy for Cutting Drug Prices Is DOA737JAN 13, 2017 8:00 AM ESTByMegan McArdleTrump didn’t say a whole lot in his press conference on Wednesday, but his remark that America needed to revise its process for buying pharmaceuticals made some enormous waves. “They’re getting away with murder,” he said. Big Pharma lost almost $25 billion in market value in just 20 minutes.

From the size of the market’s reaction, you would assume that pharma must really be getting away with murder. After all, the left has been insisting for years that one way to fix our costly health care system is to finally allow Medicare to negotiate drug prices the way that other countries do. And it’s hard to say that this is unreasonable: as probably the world’s single largest purchaser of pharmaceuticals, the American government ought to have a lot of bargaining power. Why in the world would Congress bind the government’s hands by refusing to let them negotiate volume discounts then?

You might thus be surprised to learn that the Congressional Budget Office has repeatedly assessed the effects of letting Medicare negotiate, and found that the fiscal benefits of that would be … basically nothing.

But how can that be?, I hear you cry. Well, because the people crying “LET MEDICARE NEGOTIATE” have fundamentally misunderstood the source of the negotiating power that allows people in other countries to enjoy lower-cost drugs.

That bargaining power does not come from sheer size. America’s large health insurers and pharmaceutical benefit managers each cover more people than, say, Norway. These companies -- which also cover a lot of Medicare and Medicaid beneficiaries -- negotiate quite fiercely on drug prices, because every dollar they shave off the price is either a dollar in their pocket, or a dollar of savings they can shave off their own prices, thus giving them an advantage over their competitors.

If size and willingness to negotiate were all that mattered, then drug prices in America ought to be lower than they are abroad. They aren’t. So, obviously, size is not the primary issue. What is different in other countries is the willingness to simply say, “No, you can’t sell us your drug” (or “You can’t sell it at a high enough price to make it worth your while”, which amounts to the same thing).

This is handled differently in every country, so it’s hard to draw gross generalizations. But one we can draw is that a lot of other places are willing to look at a drug’s potential benefit, compare it to the cost, and say, “Yeah, you know, that drug delivers some benefit. But it’s not a big enough benefit to justify approving it.”

When there’s only a single source for a given drug, and the person on the other side of the table knows that you can’t refuse to cover that treatment, it’s pretty easy for them to make an offer you can’t refuse. Holding out the possibility that you’ll just walk away shifts the balance of power back across the table. But of course, this comes at a cost: to make that threat credible, you have to actually use it sometimes. And when you do, there will be people who could benefit from the drug, but can’t have it. Those people will be sicker than they would be if they didn’t get the newer drug. They might even die sooner than they otherwise would have.

That reality is politically toxic. So politically toxic that I have literally had the experience of being on a radio program with a British health official who accused me of lying when I pointed out that the United Kingdom has an agency that does this. I gave a description of its activities not materially different from that found on the website of the agency in question; however, I also pointed out the logical corollary, which is that Britain decides there are some people who aren’t worth treating, because whatever benefit they get isn’t worth the exorbitant cost. I did not, mind you, say that Britain ought to treat those people; governments have budgets, and they have to decide the highest-value use of the dollars they spend. I merely pointed out that they were making cost-benefit decisions about treatment. Stating this undeniable fact was enough to trigger a frantic reaction not only from the British health official, but from the show presenter, and from a lot of angry Britons who emailed to castigate me for slandering their government.

In Britain, if a treatment isn’t available on the National Health Service, you probably don’t know what you’re missing (which is why a health official could deny it was happening). In America, however, we have a patchwork of systems, few of which employ doctors directly. If one major insurer, government or private, stops offering some fancy treatment, then patients are eventually going to find out about that treatment’s existence, and also that they can’t have it.

Thanks to the internet, other countries are having a harder time keeping a lid on this sort of thing than they used to. But in America, where the mantra of both sides is that no one should be interfering with choices properly left to doctors and patients, it’s incredibly difficult to exercise this sort of discipline. Oh, sure, wonks may like the idea of a panel of experts that says “Nope, that $90,000 Hepatitis C treatment just isn’t worth it.” But no one else does. And our political system, with its multiple power centers and widespread opportunities for lobbying by both corporate interests and activist groups, is not well-positioned to override the public at large and exercise pricing discipline anyway. If Medicare announced, in the course of negotiations, that the U.S. government simply wasn’t going to cover large numbers of chemotherapy drugs, both cancer groups and the AARP would have baby kittens. Then the legislature would go into overdrive, rescinding that order. Since pharmaceutical firms know that, the outcome would be … well, pretty much what we have now.

Glad we talked that through? Me too.

It’s not particularly surprising that Donald Trump doesn’t know this—frankly, I doubt that Obama does either. Nor is it necessarily surprising that he has seized this talking point, since it’s a very common one in the health care debate. What is interesting is that this is where he chose to go in a press conference where he didn’t speak for all that long. It’s reminiscent of behavior we heard about during the campaign, where small vendors complained that he forced them to take steep haircuts by the simple expedient of giving them “take it or leave it” offers after they’d already done the work or delivered the product. Because suing him would mean losing even more on lawyer’s fees, they often took it.

Trump’s idea of good management often seems to begin and end with driving a really hard bargain. (Though perhaps at some cost in the future, which is certainly a big worry when you consider that driving pharmaceutical prices too low might choke future innovation). But Trump was not building hotels with 300 million auditors looking over his shoulder, and a 500-member board of directors who could overrule him when the auditors got mad. He still has to learn just how little power our new Negotiator-in-Chief has when it comes to stuff that Americans really care about. For that reason, among others, Wednesday’s press conference should probably make us more worried about the future of his presidency than the future of Big Pharma.

* Intelligence briefings* Meeting with the CEO's of small and community banks* Budget meeting* Meeting with Pete Peterson, former Secretary of Commerce* Meeting with John Kelly, Secretary of Homeland Security and Mike Pompeo, Director of the CIA* Meeting with high school students enrolled in the United States Senate Youth Program

U.S. and Ukrainian authorities have expressed interest in the activities of a Kiev-based operative with suspected ties to Russian intelligence who consulted regularly with Paul Manafort last year while Manafort was running Donald Trump’s presidential campaign.

The operative, Konstantin Kilimnik, came under scrutiny from officials at the Federal Bureau of Investigation and the State Department partly because of at least two trips he took to the U.S. during the presidential campaign, according to three international political operatives familiar with the agencies’ interest in Kilimnik.

Kilimnik, a joint Russian-Ukrainian citizen who trained in the Russian army as a linguist, told operatives in Kiev and Washington that he met with Manafort during an April trip to the United States. And, after a late summer trip to the U.S., Kilimnik suggested that he had played a role in gutting a proposed amendment to the Republican Party platform that would have staked out a more adversarial stance towards Russia, according to a Kiev operative.

The FBI declined to comment on Kilimnik, while the State Department did not respond to a request for comment. It’s unclear whether either agency launched any kind of official inquiry into Kilimnik, nor is it clear whether the interest from the U.S. authorities is ongoing

[...]

Trump kan weer gaan twitteren over fake news.

I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they've always worked for me.

[...]Those employees who remain are frequently accused of “thwarting” President Trump’s agenda. This is a serious accusation, but one that hasn’t manifested evidence or shown any distinction from bureaucratic shirking problems that have plagued every prior administration (Obama’s travails with the Pentagon come to mind). Government sausage-making is no silent coup. Presidents do not rule by a Picard-like “make it so,” and agencies have an obligation to present policy advice based on the best facts available. When the Department of Homeland Security’s intelligence unit failed to find that the countries implicated in the president’s refugee executive order present a terror threat, the analysts were just doing their jobs—not defying the president. When government lawyers shared legal concerns about the so-called travel ban, they were just offering their best advice. To Trump, perhaps the end result feels the same: He is not getting all he wants and the bureaucracy is telling him no. But this happens to all presidents. The difference with Trump is that he can’t handle the truth.

[...]

I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they've always worked for me.